Experiencing how spinal fusion treats scoliosis before surgery day

The Spinal Program at Boston Children’s Orthopedic Center has partnered with the Simulator Program to offer a unique simulation experience to patients who will undergo surgical treatment for scoliosis, a procedure called spinal fusion, this summer.

“In my experience, patients do better when they are well prepared for surgery,” says Dr. Michael Glotzbecker, a pediatric spine specialist and surgeon at Boston Children’s Hospital, who performs dozens of spinal fusion surgeries each year to treat children with scoliosis.

That’s why Glotzbecker teamed up with Brianna O’Connell, a child life specialist and program lead of simulation programs for patients and caregivers at the Boston Children’s SIMPeds Simulator Program, to create an immersive day for patients and their families to experience spinal fusion well ahead of surgery day.

Many of the children and adolescents who attended the spinal fusion simulation, held in April 2017, have their surgeries scheduled for this summer, during their school break. The simulation included realistic set-ups of the pre-op, operating room, recovery room and inpatient hospital room as well as all the medical equipment and procedures that they will experience during their stay at Boston Children’s and what to expect after discharge home.

“It was a great opportunity to familiarize kids with what they will see and experience on surgery day and beyond, and give them the chance to ask questions about things they may be curious or worried about,” says O’Connell.

Here’s a step-by-step look at what patients and families experienced during the spinal fusion simulation:

On their first stop during the spinal fusion simulation experience, patients learned what to expect during pre-op. They looked at hospital gowns and got familiar with the pain-free IV system. A burst of topical anesthetic numbs the skin and then a very thin, flexible and soft IV is inserted into a vein in the arm. There’s no need to worry that moving around will damage the vein or needle. Here, a mannequin is given medicine intravenously.At the next simulation station, Glotzbecker used a spinal model to show patients how rods and screws will be used to straighten the spine. Many patients were concerned that the screws would be near their spinal cord; Glotzbecker showed them the location of the spinal cord and explained that the screws safely go into vertebrae bones on either side of the cord.Next, patients entered a realistic simulation operating room. So realistic, in fact, that the room is used by surgical teams to practice new procedures. At this station, patients learned about the different monitors that would be used to assist the surgical team during the surgery and what to expect when they are given anesthesia in the operating room. The surgical team explained that everyone in the room will be wearing masks and gowns and that patients should expect to fall asleep with a flock of caregivers surrounding them and taking care of them. Once asleep, patients will be gently rolled onto their stomachs. A surgical drape will be placed over them, so that only the area of their spine is exposed during surgery.Here, a nurse explains who the members of the surgical team are. In addition to the surgeon and anesthesiologist, there are many assistants and nurses who help make the surgery go safely and smoothly. Throughout the procedure, the team closely monitors neurological activity to make sure that their manipulation of the spine does not have any adverse impact on motor skills.Patients and their families got up close and personal with some of the equipment and materials that will be used during spinal fusion. Here, they test out soft padding that will be used to pad the patients’ knee and hip bones while they are lying asleep during the long surgery.The surgical table for spinal fusion is a special, adjustable surface that cradles a patient’s body while they lie face down during the surgery. Here, a nurse presses upon the table’s cushiony material, demonstrating how supportive it is.Next, patients learned that after waking up from anesthesia, they can expect to be a bit disoriented. Their parents may or may not be in the recovery room yet, but there will be no need to worry. A nurse explained that as soon as a patient begins to wake up, mom and dad will quickly arrive at their bedside. While waking up, patients will notice that they are wearing an oxygen mask, just like the one being tried out in the picture above.After recovery, patients will be brought to their hospital room in the 10 Northwest wing of Boston Children’s, where they will remain for the next few days until they are ready to go home. Here, a nurse practitioner uses a medical mannequin to show patients the type of bandage that will be worn after surgery to protect their surgical incision.Patients will receive round-the-clock care and can expect nurses to periodically check their vital signs. Here, a patient tries out a stethoscope and checks to see if she can find a pulse on a hi-fidelity medical mannequin (which has a pulse, heartbeat and lung sounds). In the first day after surgery, patients will be able to manage their pain by pushing a button that releases painkillers through their IV line. Soon, patients can expect to be switched to oral painkillers to help keep them comfortable while they heal.This is a sample of a coping kit, which is one of the tools that child life specialists use to help patients cope with procedures, any post-op pain they may have and the general hospital experience.At the simulation event, a patient who has already undergone spinal fusion at Boston Children’s (right) was available to answer questions about her experience. One question she received was how long it was before she could return to being active after surgery. She explained that it’s different for each person, but that activity can increase gradually in parallel with the spine’s healing process. Patients should expect to work closely with their surgeon to determine when it’s appropriate to resume various activities. Today, a year after surgery, this former patient is back to running cross country and doing all the things she did before her spinal fusion.Physical therapy is an essential part of successful spinal fusion. While staying in the hospital post-op, physical therapists will visit the patient to help them complete milestones like walking down the hallway and using the bathroom on their own. These and other milestones make up a checklist that must be completed before patients are ready to go home. The simulation prepared patients for what to expect during their stay at the hospital and — by using a room that mimics a child’s bedroom — also when they return home and continue their recovery there. Patients should be ready to get familiar with the “log roll”, demonstrated here, which is a technique for getting out of the bed that prevents any bending or twisting of their spine.

“Since opening our Simulation Center in 2016, we have the ability to offer simulation to patients and families,” says Melissa Burke, director of business development at SIMPeds. “We specifically built our first simulation room to have a configuration that mimics a child’s bedroom so that we could improve the confidence of caregivers and patients going home with new medical devices. We hope to provide many other experiential learning opportunities like the spinal fusion simulation in the future.”

Although the spinal fusion simulation was a first-time pilot event, organized by Glotzbecker and O’Connell, they have already received positive feedback from the patients and families who attended. As a result, they hope to host future simulations so that upcoming spinal fusion patients also have the option to “experience” their surgery before the big day arrives.